The Productive Operating Theatre (TPOT)
The Productive Operating Theatre is a comprehensive improvement initiative designed to enable hospitals to improve patient experiences and outcomes by pursuing three main objectives:
• increase safety and reliability of care
• effective teamwork and improved staff morale
• value and efficiency.
Implementing the TPOT programme will provide the hospital with an opportunity to improve the quality and safety of surgical services through Quality Improvement (QI) methodologies and effective team-working. Cost containment measures and greater safety coupled with an increased demand for healthcare services are well-established drivers for change and improvement. External factors such as new treatment modalities and revised international norms and standards must also be observed. These factors all impact on work processes and systems within the operating theatre environment.
CUH has commenced the process of implementing TPOT and is presently signing off the criteria for Participating Acute Hospitals undertaking the TPOT Quality Improvement (QI) initiative. Listed hereunder are the benefits realised to date from the implementation of the programme:
• Reduction in number of theatre nurses on call from 11 WTE per night to 8WTE per night;
• Opening of in hours emergency theatre in November 2011-initial call savings approximately €85,000 - €90,000;
• Installation of computers in in each theatre;
• iPMS installed l in theatres and data inputted by staff. Data being captured on excel spread sheet in Theatre 9, Emergency Theatre and orthopaedic theatre;
• Installation of interactive white board in theatre recovery facilitation real time information for staff;
• Twice daily meetings in theatre with CNM3 and CNM or deputy of each theatre to ensure communication of any issues related to theatre flow;
• €305,000 saved with introduction of customized procedure packs;
• €15,000 saved on sutures and other inventory savings were made and this is an on-going project in theatre with streaming of inventory;
• On-going work in each theatre aiming to standardise areas;
• 5S project in theatre 9 facilitated the organisation of a minor ops room for local anaesthetics;
• Improved patient pathways with DOSA and Pre-admission opening, staggered admissions for patients-Increase in WTE to support this, plus full time administration support;
• Further improvement between DOSA and Theatre with the amalgamation of theatre reception and DOSA;
• Standardisation of patient documentation- inpatient and day case patients;
• Change in opening times of admissions from 7.30am to 7am as a result of project work and involving all relevant departments;
• Reorganisation of theatre stores and creating better standard and flow of sterile instrumentation packs;
• Lean education – Staff education in green belt, black belt and yellow belts – improvement projects undertaken by staff while undertaking these courses;
• Walking patient to theatre and now where feasible walking patients directly into theatre- more efficient;
• Improved theatre start times due to improved pathways;
• Reduction in Intra Operative Interval (IOI) by 10 min;
• Electronic schedule (always available);
• Kanban introduced-cost of stock to be removed from pilot Savings in stock issues in pilot theatre Theatre (based on average cost price);
• Cabinet and 5S inventory savings;
• Standard work practice for all medical secretaries;
• Greater visibility across the different functions.
The EMB is mindful of the resources expended in theatre and information from the theatre management system will be critical in supporting the implementation of Activity Based Funding.